Contrast-enhanced mammography in screening and symptomatic work

Contrast-enhanced mammography (CEM) is an advanced breast imaging technique that enhances traditional mammography with iodine-based contrast, offering both structural and functional insights. It significantly improves cancer detection, especially in women with dense breast tissue, where conventional mammography often falls short. CEM demonstrates high sensitivity and specificity, rivalling breast MRI in many diagnostic scenarios, including pre-operative staging, problem solving in symptomatic clinics and monitoring response to neoadjuvant chemotherapy.

In symptomatic pathways, CEM aids in evaluating indeterminate findings, guiding surgical planning and reducing unnecessary biopsies. It is particularly effective in dense breasts and offers a practical alternative when MRI is contraindicated or unavailable. In screening contexts, early studies show promising results, with higher cancer detection rates in intermediate and high risk populations. Ongoing trials like BRAID, CMIST and DENSE-2 aim to define its role in risk-adapted screening models.

CEM’s accessibility, cost effectiveness and efficiency make it a valuable tool in modern breast imaging. Emerging applications include CEM-guided biopsies and lesion localisation. Despite its advantages, widespread adoption is limited by institutional variability and resource constraints. Future advancements in AI, image resolution and workflow integration are expected to further establish CEM as a key modality in breast cancer detection and management.

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